Content area
Full Text
SUMMARY
The aim of our study was to describe the knowledge and practice of New Zealand anaesthetists in relation to perioperative beta-adrenergic blockade, and to define barriers to implementation of perioperative beta-blockade in surgical patients at risk of myocardial ischaemia.
A survey was sent to 400 New Zealand specialist anaesthetists. Information was sought on their knowledge and cwrent practice relating to perioperative beta-blockade, and the barriers encountered to implementing therapy.
The response rate was 59%. Perioperative beta-blockade was seen as beneficial in at risk patients by 95% of responding anaesthetists, but practice varied widely. Only 45% of anaesthetists always or usually commenced a beta blacker perioperatively, a department protocol was available to only 20%, and understanding of indications and contraindications to beta-blockade varied. There were logistical difficulties when initiating and monitoring perioperative beta-blocker regimens, and where treatment required multidisciplinary commitment. The lack of clarity of the guidelines was also a barrier to more widespread use. Difficulties were encountered relating general guidelines to individual patients, when co-morbidities, concurrent treatment and the influence of regional or general anaesthesia may influence the risk/benefit ratio.
This study has identified variations in practice and reasons why New Zealand anaesthetists use of perioperative beta-blockers is at odds with published guidelines. Deficiencies in the guidelines are part of the problem. However, even with consensus on guidelines, effective multidisciplinary strategies will be required to optimize treatment of patients at risk of perioperative cardiac events.
Key Words: ANAESTHESIA, BETA-BLOCKADE: cardiac morbidity, practice guidelines, perioperative period, clinical surveys, risk factors
Is there sufficient evidence to change practice in regard to perioperative beta-adrenergic blocker therapy? A number of randomized controlled trials have announced impressive reductions in postoperative cardiac morbidity and mortality for at-risk patients prescribed perioperative betablockers1-3. Two systematic reviews of the evidence have both given qualified support to perioperative use of beta-blockers4,5. The American College of Physicians recommended the perioperative use of beta-blockers in 1997(6) and the most recent American Heart Association (AHA) guideline update for perioperative cardiovascular evaluation of noncardiac surgery, recommends that when possible, betablockers should be started days or weeks before elective surgery, with the dose titrated to achieve a resting heart rate of between 50 and 60 beats per minute". The AHA consider there is Class I support (conditions...